Neurologic, neuro-ophthalmologic, and neuropsychologic complications constitute a primary source of morbidity and disability following cardiac surgery. As many as 12,500 patients suffer frank strokes and at least 100,000 manifest measurable deterioration in psychomotor performance after cardiac surgery. Neurologic complications occur more frequently after valvular surgery and in elderly individuals. This Program Project will utilize a multidisciplinary team of investigators to determine the influence of physiologic and pharmacologic factors on the combined prevalence of new postoperative neurologic, neuro-ophthalmologic, and neuropsychologic deficits. In patients undergoing myocardial revascularization, Project 1 will determine if careful avoidance of hyperglycemia, which worsens experimental ischemic neurologic injury, will improve neurologic outcome. That project will include patients with the important risk factor of cerebrovascular disease. Project 2 will evaluate, in patients undergoing cardiac valve surgery, if the calcium entry clocker nimodipine will reduce the prevalence of new postoperative deficits. Project 3 will determine the frequency, etiology, and clinical implications of newly observed diffuse microvascular lesions after cardiopulmonary bypass. Each of the projects will be supported by the Administrative Core (Core A) and the Biostatistical Core (Core D). In addition, the Clinical Projects (1 and 2) will utilize common physiologic measurements from the Neurologic and Neurobehavioral Assessment Core (Core C). The interaction between the laboratory and clinical components will enhance the productivity of both components and will maximize the likelihood of deriving clinically useful information from the Program Project. Demonstration of improved outcome in any of the clinical projects should immediately be applicable to thousands of patients.